Provider Demographics
NPI:1114517828
Name:DEMASTRY KOLIKOHN, NICOLE M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:DEMASTRY KOLIKOHN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 PLEASANTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9348
Mailing Address - Country:US
Mailing Address - Phone:740-503-5025
Mailing Address - Fax:
Practice Address - Street 1:1897 PLEASANTVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9348
Practice Address - Country:US
Practice Address - Phone:740-503-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily